Diabetic Ketoacidosis

What Is Diabetic Ketoacidosis?

Diabetic ketoacidosis (DKA) is a serious condition that is linked to diabetes. If you don’t have enough insulin to help your body process sugars (glucose), your body will start burning fat to fuel itself. As a result, acids called
ketone bodies build up in the body.

Left untreated, these ketone bodies poison you. DKA can occur in people who have type 1 or type 2 diabetes, but it’s considered more rare in those with type 2. DKA can also appear if you are at risk for diabetes but have not
received a formal diagnosis. It can be the first sign of type 1 diabetes.

DKA is a medical emergency. If you suspect this complication, immediately contact your physician or go to an emergency room.

If you have type 1 diabetes and have a glucometer reading of over 300 milligrams per deciliter, you should test your urine for ketones. Call your doctor if moderate or high levels of ketones are present. Always seek medical
help if you have unexplained nausea and vomiting.

What Causes Diabetic Ketoacidosis?

The most common triggers for the breakdown of fat that causes DKA are:

missing an insulin injection or not injecting enough
insulin

illness or infection

for people that are using an infusion pump, a clog in
the pump

Who Is at Risk for
Developing Diabetic Ketoacidosis?

Your risk of developing DKA might be higher if you:

have type 1 diabetes

are under the age of 19

have had some form of trauma, whether emotional or
physical

stress

have a high fever

have had a heart attack or stroke

smoke

abuse drugs or alcohol

Although DKA is rare in people who have type 2 diabetes, it does occur.

What Are the Symptoms of Diabetic Ketoacidosis?

Symptoms of DKA can appear quickly and may include:

frequent urination

extreme thirst

nausea

vomiting

abdominal pain

confusion

breath that smells fruity

a flushed face

fatigue

rapid breathing

dry mouth and skin

If you have type 1 diabetes, you should maintain a supply of home urine tests. A high ketone test result after one of these tests is a symptom of DKA. This test may show that you have high ketone levels in your urine.

If left untreated, DKA can lead to a coma or death. All people who use insulin should discuss the risk of DKA with their healthcare team, to make sure a plan is in place.

It is important to make sure you consult with your doctor if you experience any of these symptoms:

inability to keep food or liquid down

blood sugar levels of 240 mg/dL or more that do not
come down after treatment at home

multiple signs of DKA

How Is Diabetic Ketoacidosis Diagnosed?

Testing for ketones in a sample of urine is one of the first steps for diagnosing DKA. Tests of blood acidity and sugar levels are also commonly done. Other tests your doctor may order are:

potassium blood test—to assess metabolic function

arterial blood gas—to determine the acidity of your
blood

amylase blood test—to test pancreatic function

chest X-ray—to look for signs of an infection such as pneumonia

How Is Diabetic Ketoacidosis Treated?

The treatment for DKA usually involves a combination of several approaches to normalize abnormal blood sugar and insulin levels. If you’re diagnosed with DKA but have not yet been diagnosed with diabetes, your doctor will create a diabetes treatment plan to keep ketoacidosis from reoccurring. If your DKA is a result of an infection or illness, your doctor will treat that as well, likely with antibiotics.

Fluid Replacement

You should replace fluids. At the hospital, your physician will likely give you fluids (orally, if possible, or intravenously) to replace the fluid that is usually lost as a result of DKA. Fluid replacement is also helpful in diluting the amount of sugar in your blood.

Electrolyte Replacement

Lower than normal levels of insulin can cause the levels of electrolytes in your body to become abnormally low. Electrolytes are electrically charged minerals that help your body—including the heart and nerves—function properly. Electrolyte replacement is also commonly done intravenously.

Preventing Diabetic Ketoacidosis

There are many ways to prevent DKA. One of the most important is proper management of diabetes. Take your diabetes medication as directed, eat healthfully, and monitor your blood glucose to help prevent DKA.

Additional preventive measures include:

making sure that your blood sugar levels are within
their normal range by checking them several times per day

never skipping insulin doses

talking to your doctor about adjusting your insulin
dosage levels based on your activity level, illnesses, or other
factors, such as what you’re eating

developing an emergency or
“sick-day” plan so you will know what to do if you develop DKA symptoms

testing your urine for ketone levels during periods of
high stress or illness—tåhis can help you catch moderate to high ketone
levels before they threaten your health

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